If you're moving to France to live, it's likely that you will need a visa and this may come with requirements concerning health cover.
But once you have been living in France for a certain period of time you're entitled to register within the French system for state healthcare, so it's really a two-step process regarding your health cover.
If you're only visiting - whether as a tourist or someone with a visitor visa - the system is different
Health insurance in France: What are the requirements for visitors and residents?
Importantly, paying for private health insurance does not necessarily give you quicker or better access to medical treatment in France.
Healthcare here is routinely and universally excellent.
The first three months
For most types of visa to stay in France, holders will be required to demonstrate an ability to cover the cost of any healthcare.
This usually means having some form of private insurance to cover the costs of medical repatriation, and emergency and/or hospital treatment to a minimum amount - usually €30,000 - for the length of any stay.
Obviously, this insurance needs to extend cover to France. It is important to note that an American health insurance card is not proof of adequate coverage.
READ MORE: Urgent care: How to get non-emergency medical treatment in France
After three months
Anyone who has lived in France for three months and established residency, is eligible to register within the French state health system.
For this, you will need a numero de securité sociale and a carte vitale - you can apply for this at the Assurance Maladie website www.ameli.fr
READ ALSO How to get a carte vitale
Once you are registered in the French system, you can then cancel your private health insurance policy - visas only require that you have health cover, and that can include cover from the French system.
However getting yourself registered can take some time - up to six months is common - so we would suggest you don't cancel the insurance until you are registered and have your carte vitale, just in case.
How the French system works
The French state health system is an insurance system - it's known as Assurance maladie (health insurance) - and the basic premise is that for any medical cost (a doctor's appointment, a prescription, a medical procedure) you pay upfront and the government then reimburses you with part or all of the cost.
The green-and-yellow credit card-sized card known as a carte vitale is proof that you are registered in the French healthcare system.
Its microchip contains details of your rights to health cover, and will be routinely requested by your doctor, pharmacist, dentist etc.
It guarantees that the State will repay its share of your healthcare costs - which can be anything from 30 percent to 100 percent of the total costs depending on your circumstances.
Once you have paid the health professional, they then swipe your carte vitale and the money goes straight into your bank account within a couple of days - there is no need for you to take further action.
Retirees
If you're working in France then you're paying taxes and in exchange the French state will pay your healthcare costs.
If you’re not working, you can register for French healthcare through the PUMa system. Keep in mind that depending on your income and situation, you may need to pay a sum of yearly charges.
If you are retired and have a state pension from an EU country (or one with a bilateral agreement with France), then usually the French state will pay your costs but then reclaim them from that country.
But however your healthcare is paid for, you simply swipe the carte vitale and get the money back in your bank account.
‘Top-up’ health cover
As mentioned above, the state system only reimburses a percentage of your costs.
How much is reimbursed is complicated and depends on the type of appointment, type of medical condition being treated and your personal circumstances (eg if you're pregnant, on benefits or a war veteran).
For example, a standard visit to your family doctor (médecin traitant) costs €25 and is reimbursed at 70 percent, so you get €16.50 back.
Certain conditions, such as cancer or endometriosis, have 100 percent reimbursement where all your costs are taken care of, while others have a rate of 70 or 80 percent reimbursement.
There are a lot of exceptions however and it's all quite complicated - full details HERE.
In order to cover the extra bit, 96 percent of French people have 'top-up' cover, known as a mutuelle.
This takes care of all the extra costs and depending on the policy also covers things like spectacles, hearing aids and dental prothesis or cosmetic treatments.
The first thing you will notice about a mutuelle is that they are considerably cheaper than US private health insurance.
The average cost depends on age, for a single person under 25 the average in 2022 was about €28 per month for a single person, rising to about €98 for the average family of four. If you are an employee, your employer is legally obliged to pay at least half of the cost of your mutuelle.
READ ALSO What you need to know about a French mutuelle
Private insurance
There is no obligation to be registered in the French state system and you can continue to pay for private health insurance if you want.
It doesn't really give you much of an advantage, though, as French state healthcare is of a very high standard. If you do decide to do this, you will notice that the costs for medical treatments, drugs etc are a lot lower than you are used to back in the US.
It can be helpful to be registered in the state system so that you will routinely be included in public healthcare campaigns. Once you have your details registered you will then be invited for relevant appointments, for example for pap smears or the flu vaccine, depending on your health needs.
It is possible to be registered in the state system and continue to pay for private health insurance if you want.
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